A Fight for No Judgment

In the midst of Pride Month, Mayor Bill de Blasio’s administration took a stand by enacting the first-ever LGBTQ Health Care Bill of Rights. It’s a push to help LGBTQ New Yorkers get proper health care by offering them protections on the local, state and federal level. On a similar mission, the Health Department created Bare It All, a sexual health awareness campaign to encourage LGBTQ to be open with their doctors about their medical needs.

These measures are necessary. About 30 percent of transgender patients said they delayed or didn’t seek medical care because of discrimination, according to a 2016 report in the journal Medical Care. A 2015 study from the National Institutes of Health also found that about half of first-year medical students “expressed at least some explicit bias” against gay and lesbian people in a baseline survey.

You’ve been a physician for over two decades now. What is one of the biggest changes you’ve seen? In the 80s when I was still practicing my residency—I was in hospitals in [Manhattan] and Brooklyn—you saw 26 year olds come in on a Monday afternoon with a bad cough and by the following week, they had lost 30 pounds, they were on respirators for respiratory failure. Healthy looking, young, good patients were melting away within days, weeks before your eyes. It was this horrible nightmare of a disease called HIV that we didn’t really know very much about. Over the years I’m glad to say I have at least a half a dozen patients with HIV and they are taking a big regimen of medical therapy every day but they are doing great and they have a good quality of life.

What are some of the biggest medical issues the LGBTQ community faces today? They actually have many of the same issues that we all have. But there’s greater concern for what their risk is today for contracting HIV and how that is really going to affect their quality of life. The problem is that a lot of the younger patients I am seeing now didn’t see the bad initial days of the battle against HIV and what a deadly illness it was [in the 80s]. They almost feel that, “Well can’t you give me a pill to get rid of it?” And I explain to them it’s not that simple. This used to be a disease where contracting the flu or cold could be a catastrophic event. What I try and stress to the patient is more about prevention than just taking the pill to treat the disease.

What are some common questions they have? One of the bigger questions I get these days is about the new therapy called PrEP. It came out about a year ago and stands for pre-exposure prophylaxis. This is a groundbreaking therapy. It’s a way for people who don’t have HIV, but who perhaps have substantial risk of getting it, to help prevent HIV infection. They do this by taking a pill once daily [that] contains two medications that are used in combination with other medicines often to treat HIV. This medication works by blocking the important pathways that HIV uses to set up an infection. It basically helps the virus from replicating inside the body. When you have this PrEP in your bloodstream, it can often stop the HIV from taking hold and spreading throughout the body.

Anyone can come in and ask for this pill and get it? Yes. It goes under the brand name of Truvada. It’s a nice medication for practicing patients who are particularly out in an environment where they are single and they are meeting partners they don’t know all that well…But my problem with that is they sometimes think when they take this pill that they don’t have to practice safe sex and that’s simply not true. You can still get everything from gonorrhea, chlamydia, hepatitis. Even with this PrEP medical therapy, the chances of reducing a risk of HIV is far greater when used with safe sex practices.

The Health Department launched the new Bare It All sexual health awareness campaign to encourage the LGBTQ community to speak more openly with doctors. Do you find that patients from the LGBTQ community have a harder time being more open than other patients?Often yes because when they don’t know you as a doctor, they are feeling you out to see if you are going to be judgmental, to see if there is any stigma attached from your perspective. But I think once the patient understands that you are there for them and you are there to help them and you are supportive of them, you basically create an affirmative environment…And I think patients are opening up far better now than they did years ago.

How can doctors make these patients feel comfortable? The primary thing is to never appear judgmental to a patient. Always let them know you are their advocate and to keep it where it’s an environment open to dialogue. A lot of times doctors don’t realize that you need to listen to your patients, hear what they are saying, hear what their concerns are.

Do you think it was necessary to launch such an awareness campaign? I think it was very helpful and helping us all to be more aware. And maybe force us to keep up on what we are able to do to help our patients.

What is one of the biggest misconceptions about the LGBTQ community you encounter in terms of their medical needs? The biggest misconception is that they [aren’t the same]. These patients are the same as the rest of us. They want to be healthy, they want to stay happy, they want to do everything they can to not get ill so they can have a normal life with their loved ones…and they want us not to judge them or look down on them…and we owe it to them to keep up with the medical literature and look into all new treatments that are available to treat their issues and concerns.